Cuff Group Research Articles

Supraspinatus Muscle and Tendon Stiffness Changes After Arthroscopic Rotator Cuff Repair: A Shear Wave Elastography Assessment.

Re-tearing after arthroscopic rotator cuff repair (ARCR) frequently occurs, and high stiffness of the rotator cuff may be one of the factors. We investigated changes in stiffness of the supraspinatus muscle and tendon after ARCR as measured by shear wave elastography (SWE) with B-mode ultrasound, and compared the supraspinatus muscle stiffness of patients with recurrent tears and patients with healed rotator cuffs. Sixty patients with supraspinatus tears requiring ARCR underwent serial SWE of their supraspinatus muscles and repaired tendons. SWE was performed before surgery (Pre-Op) and at 1 week, 1 month, 2 months, 3 months, 4 months, 5 months, and 6 months after surgery. Additionally, the repaired rotator cuffs were evaluated using magnetic resonance imaging at 6 months after surgery to classify patients into a healed rotator cuff group and a recurrent tear group. Differences in SWE values between the groups were assessed at each time point. The SWE value of the repaired tendon at 1 week after ARCR was significantly greater than at 3 and 6 months. The SWE value for the supraspinatus muscle at 1 month after ARCR surgery in the healed group was lower than at Pre-Op and 4, 5, and 6 months after surgery, and it was also lower than that at 1 month after surgery in the re-tear group. There were no significant differences between time points in the SWE values of the supraspinatus muscle in the re-tear group. The SWE value of the muscle in the re-tear group was greater than in the healed group at 1 month after surgery (p < 0.05). Increased SWE values at 1 month after ARCR may predict recurrent rotator cuff tears after surgery rather than evaluating the tendon. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:219-227, 2020.

Prevention of Lung Bacterial Colonization With a Leak-Proof Endotracheal Tube Cuff: An Experimental Animal Study.

Endotracheal tubes with standard polyvinyl chloride cuffs create folds on inflation into the trachea, which lead to potential leakage of subglottic secretions into the lower airways and cause lung colonization and pneumonia. The use of a double-layer prototype leak-proof cuff has shown effective prevention of the fluid leakage across the cuff. We hypothesized that the use of such a leak-proof cuff could prevent lung bacterial colonization in vivo. To simulate patients in the ICU, 13 pigs were placed in the semirecumbent position, intubated, and mechanically ventilated for 72 h. Five animals were prospectively intubated with an endotracheal tube with a leak-proof cuff (leak-proof cuff group). Data from 8 animals previously intubated with an endotracheal tube with a standard polyvinyl chloride cuff (standard cuff group) were retrospectively analyzed. Leakage of tracheal secretions across the leak-proof cuff was tested by the macroscopic methylene blue evaluation. Arterial blood gas exchanges and microbiology were tested in all the pigs at necropsy. In the standard cuff group, all the pigs showed heavy bacterial colonization of the lungs after 72 h of mechanical ventilation, with an overall proportion of colonized lung lobes of 92% (44/48 lobes, 8/8 animals) compared with 27% (8/30 lobes, 5/5 animals) in the leak-proof cuff group (P < .001). These results were strengthened by the absence of methylene blue in the tracheal secretions below the leak-proof cuff. Furthermore, no hypoxemia was demonstrated in the pigs in the leak-proof cuff group after the 72-h experiment (PaO2 /FIO2 change from baseline, leak-proof cuff group vs standard cuff group; median difference 332, 95% CI 41-389 mm Hg; P = .030). A new leak-proof cuff for endotracheal intubation prevented macroscopic leakage of subglottic secretions along the airways. This mechanism led to the reduction of lung bacterial colonization, which could contribute to the prevention of hypoxemia in the pigs on mechanical ventilation while in the semirecumbent position.

Intraoperative evaluation of blood flow for soft tissues in orthopaedic surgery using indocyanine green fluorescence angiography: A pilot study.

ObjectivesIndocyanine green (ICG) fluorescence angiography is an emerging technique that can provide detailed anatomical information during surgery. The purpose of this study is to determine whether ICG fluorescence angiography can be used to evaluate the blood flow of the rotator cuff tendon in the clinical setting.MethodsTwenty-six patients were evaluated from October 2016 to December 2017. The participants were categorized into three groups based on their diagnoses: the rotator cuff tear group; normal rotator cuff group; and adhesive capsulitis group. After establishing a posterior standard viewing portal, intravenous administration of ICG at 0.2 mg/kg body weight was performed, and fluorescence images were recorded. The time from injection of the drug to the beginning of enhancement of the observed area was measured. The hypovascular area in the rotator cuff was evaluated, and the ratio of the hypovascular area to the anterolateral area of the rotator cuff tendon was calculated (hypovascular area ratio).ResultsICG fluorescence angiography allowed for visualization of blood flow in the rotator cuff in all groups. The adhesive capsulitis group showed significantly earlier enhancement than the other groups. Furthermore, the adhesive capsulitis group had a significantly smaller hypovascular area ratio than the other groups.ConclusionICG fluorescence angiography allowed for evaluation of real-time blood flow of the rotator cuff in arthroscopic shoulder surgery. The techniques of ICG fluorescence angiography are simple and easy to observe, observer reliability is high, and it has utility for evaluating blood flow during surgery.Cite this article: N. Doi, T. Izaki, S. Miyake, T. Shibata, T. Ishimatsu, Y. Shibata, T. Yamamoto. Intraoperative evaluation of blood flow for soft tissues in orthopaedic surgery using indocyanine green fluorescence angiography: A pilot study. Bone Joint Res 2019;8:118–125. DOI: 10.1302/2046-3758.83.BJR-2018-0151.R1.

Difference of Critical Shoulder Angle (CSA) According to Minimal Rotation: Can Minimal Rotation of the Scapula Be Allowed in the Evaluation of CSA?

BackgroundMinimal rotation of the scapula may affect the measurement of critical shoulder angle (CSA). We investigated the difference in the CSA measured in minimal rotation between the patients with rotator cuff tear and those without non-rotator cuff tear and the CSA measurement error by comparing with computed tomography (CT).MethodsWe retrospectively reviewed patients with full-thickness rotator cuff tear and whose X-ray views correspond to Suter-Henninger classification type A1 and C1. The CSA values between the normal control group (without rotator cuff tear) and the rotator cuff tear group were compared according to A1 type and C1 type. In the rotator cuff tear group, we compared the CSA values measured by using X-ray and CT.ResultsA total of 238 patients (rotator cuff tear group, 139 patients; normal cuff group, 99 patients) were included in this study. The mean CSA of the rotator cuff tear group was 33.4° ± 3.5°, and that of the normal cuff group was 32.6° ± 3.9° (p = 0.085). On comparison of the CSA according to the Suter-Henninger classification type, the CSA values on the A1 type view and C1 type view were 32.7° ± 3.5° and 33.7° ± 3.5°, respectively, in the rotator cuff tear group and 30.5° ± 3.1° and 33.1 ± 3.9°, respectively, in the normal cuff group (p = 0.024 and p = 0.216, respectively). The mean CSA was 32.5° ± 3.1° in CT and 33.3° ± 3.2° in X-ray (p = 0.184). On comparison of the CSA according to the Suter-Henninger classification type, the CSA values on the A1 type view and C1 type view were 32.6° ± 3.6° and 32.5° ± 2.4°, respectively, in CT and 32.5° ± 3.5° and 34.2° ± 2.6°, respectively, in X-ray (p = 0.905 and p = 0.017, respectively).ConclusionsThe X-ray view corresponding to Suter-Henninger classification type A1 or CT-reconstructed image can be used to reduce the measurement error and obtain reliable CSA values. The CSA measured on the X-ray view corresponding to Suter-Henninger classification type A1 may be related with rotator cuff tear.

A cooling cuff compared to a moist ice pack on radial artery blood flow and lumen diameter in healthy participants.

BackgroundCryotherapy is a favourable treatment for post-traumatic injuries in the acute stage because of its effect on inflammation and pain. A novel cooling cuff, which can be easily used and can be wrapped around the injured area that does not require freezing, has been developed. Its efficacy compared to traditional ice therapy has not been established.AimTo establish the effect of a cooling cuff on radial artery blood flow and lumen diameter compared to moist ice.SettingChiropractic clinic and radiographic laboratory.MethodA controlled laboratory pre-test post-test investigation assessed asymptomatic participants who were randomly allocated into a moist ice pack (n = 22) or the cooling cuff (n = 21) group. The intervention was placed on the participants forearm over the radial artery for 15 min. Data was collected by a qualified diagnostic radiographer using Doppler ultrasound. Data was analysed, using repeated measures analysis of variance to assess changes in blood flow and lumen diameter pre- and post-intervention. A p-value of less than 0.05 was considered significant.ResultsBoth groups showed a significant decrease in radial artery blood flow (p < 0.001) after 15 min with no significant changes being observed in diameter size. No significant differences were observed between the groups for radial artery blood flow or diameter.ConclusionThe cooling cuff resulted in a similar effect on radial artery blood flow and lumen diameter as moist ice, indicating that patients and practitioners may utilise the cooling cuff in the acute phases of an injury to alter blood flow.

Symptoms Associated With Chronic Venous Disease in Response to a Cooling Treatment Compared to Placebo: A Randomized Clinical Trial.

The purpose of this study was to examine the efficacy of a self-administered cooling treatment on clinically meaningful differences (CMDs) in symptom changes in patients with chronic venous disease. Blinded, prospective, randomized controlled trial. Two hundred seventy-six community-dwelling adults 21 years and older with skin changes and/or a healed venous leg ulcer (Clinical-Etiologic-Anatomic-Pathologic [CEAP] 4 and 5 classification) completed the 6-month active treatment period. Participants were recruited from wound and medicine clinics and from the general population through referrals or advertisements. Participants were randomly allocated to a sham control cuff or interventional cooling cuff group. Demographic and symptom-specific data were collected at baseline and at months 1, 3, and 6 with the 11-item symptom Venous Insufficiency Epidemiological and Economic Study Quality of Life/Symptom (VEINES QOL/Sym) questionnaire subscale for heavy legs, aching legs, swelling, night cramps, heating or burning sensation, restless legs, throbbing, itching, tingling sensation (pins and needles), pain, and irritability. Participants in the intervention group received a cooling gel cuff and those in the control group received a cotton-filled cuff to be place around the most affected lower leg during leg elevation. Both groups received standard of care for their chronic venous disease with compression wraps and skin hygiene. Dosing consisted of daily 30-minute treatment for 1 month, twice weekly for 2 months, and then thrice weekly for 3 months. To analyze and compare data, a mixed percentage clinically meaningful percentage change was used to assess CMDs in symptoms between groups for treatment modality, sex, and age group. All symptoms showed improvement, with throbbing, aching, itching, and pain demonstrating the greatest CMD in response to the cooling treatment. For throbbing and aching, similar improvements were noted in response to cooling; 50% in the cooling group showed improvement, whereas 60% in both groups responded favorably to pain. More than 50% of females and males reported improvements in throbbing; both males and females reported 60% improvements in pain in response to cooling. In contrast, far fewer females reported worsening of aching in the treatment group as compared to male participants (8% vs 20%). Age differences were noted for throbbing in the younger group (<65 years of age); older individuals 65 years or older saw CMDs in aching in response to cooling. Of the 11 symptoms, aching, throbbing, itching, and pain had greater clinically meaningful improvements in response to a cooling cuff applied to lower leg skin affected by chronic venous disease. These CMDs inform evidence-based practice by enhancing clinician understanding of which symptoms, physical, physiological, and behavioral outcomes, respond to treatment change in a meaningful way for the patient.

Influence of joint kinematics on polyethylene wear in anatomic shoulder joint arthroplasty

Despite the positive results in total shoulder arthroplasties (TSAs), a higher revision rate is documented compared with total hip and knee replacements. Wear is the possible main cause of TSA failure in the long-term. This study investigated the effect of joint kinematics and the influence of the rotator cuff on the polyethylene wear performance in an anatomic TSA. Lifting a load of 2 kg with an abduction/adduction of 0° to 90° was simulated for 2 × 106 cycles as a primary motion using a fully kinematic joint simulator. A combined rotation in anteversion-retroversion of ±5° and ±10° was also simulated. The force in the superior-inferior direction and the axial joint compression were applied under force control based on in vivo data of the shoulder. A soft tissue restraint model was used to simulate an intact and an insufficient rotator cuff. The highest wear rate in the intact rotator cuff group was 58.90 ± 1.20 mg/106 cycles with a combined rotation of ±10°. When an insufficient rotator cuff was simulated, the highest polyethylene wear rate determined was 79.67 ± 4.18 mg/106 cycles. This study confirms a high dependency of the polyethylene wear behavior and dimension on the joint kinematics in total shoulder replacement. This can be explained by an increasing cross-shear stress on the polyethylene component. The results obtained indicate that additional combined kinematics are an indispensable part of wear tests on anatomic shoulder replacements.

PD39-02 EROSION RATES OF 3.5 CM ARTIFICIAL URINARY SPHINCTER CUFFS ARE SIMILAR TO LARGER CUFFS

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence: Therapy II1 Apr 2018PD39-02 EROSION RATES OF 3.5 CM ARTIFICIAL URINARY SPHINCTER CUFFS ARE SIMILAR TO LARGER CUFFS Nabeel Shakir, Maxim McKibben, Joceline Fuchs, Jeremy Scott, and Allen Morey Nabeel ShakirNabeel Shakir More articles by this author , Maxim McKibbenMaxim McKibben More articles by this author , Joceline FuchsJoceline Fuchs More articles by this author , Jeremy ScottJeremy Scott More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1914AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Since the launch of 3.5 cm artificial urinary sphincter (AUS) cuffs in the US market in 2009, the possible increased risk of erosion has been a concern. We sought to compare the outcomes of 3.5 cm AUS cuffs versus larger cuffs for men having stress urinary incontinence (SUI) with and without a history of pelvic radiation after 8 years of experience. METHODS We reviewed the records of all men who underwent AUS placement by a single surgeon between 2009 and 2017 collected in a large, tertiary male SUI database. A uniform perineal approach was used to ensure cuff placement around the most proximal corpus spongiosum after precise spongiosal measurement. Patients were stratified by cuff size and radiation status, and patient demographics and surgical outcomes were analyzed. Success was defined as patient-reported use of ≤1 pad per day. RESULTS Among 400 AUS cases included in the analysis, the 3.5 cm cuff was used in 164 (41‰) cases, while 236 (59‰) patients received 4.0 cm or larger cuffs. AUS cuff erosion was seen 34 patients, who suffered a total of 44 cuff erosions over a median follow-up of 45 months. Rate of cuff erosion was similar in the 3.5 cm cuff group (12‰, 19/164), compared to the 4+ cm group (11‰, 25/236, p=0.7) (FIGURE). On multivariate logistic regression, predictors of AUS cuff erosion include history of pelvic radiation (OR 7.27, IQR 3.19-16.6, p<0.0001), history of IPP placement (OR 3.63, IQR 1.69-7.81, p=0.0009), and coronary artery disease (OR 4.05, IQR 1.86-8.81, p=0.0005). Patient demographics were similar between the two cuff size groups, including age, BMI, comorbidities, smoking history, radiation history, prior AUS, prior inflatable penile prosthesis (IPP), and proportion of patients with prior erosions. In patients receiving larger cuffs, 19‰ (45/236) were placed using a transcorporal approach, compared to 2‰ (4/164) of those undergoing 3.5 cm cuff placement (p<0.0001). Continence rates were high among all AUS patients, with similar success in both groups (89‰ for 3.5 cm, 82‰ for 4+ cm, p=0.1). CONCLUSIONS After eight years of experience and follow-up, the 3.5 cm AUS cuff behaves similarly to 4+ cm cuffs with respect to efficacy and rates of urethral erosion. Use of any cuff in radiated patients should be approached cautiously, as risk of erosion is substantial. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e798 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Nabeel Shakir More articles by this author Maxim McKibben More articles by this author Joceline Fuchs More articles by this author Jeremy Scott More articles by this author Allen Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Differences in Risk Factors for Rotator Cuff Tears between Elderly Patients and Young Patients.

It has been unclear whether the risk factors for rotator cuff tears are the same at all ages or differ between young and older populations. In this study, we examined the risk factors for rotator cuff tears using classification and regression tree analysis as methods of nonlinear regression analysis. There were 65 patients in the rotator cuff tears group and 45 patients in the intact rotator cuff group. Classification and regression tree analysis was performed to predict rotator cuff tears. The target factor was rotator cuff tears; explanatory variables were age, sex, trauma, and critical shoulder angle≥35°. In the results of classification and regression tree analysis, the tree was divided at age 64. For patients aged≥64, the tree was divided at trauma. For patients aged<64, the tree was divided at critical shoulder angle≥35°. The odds ratio for critical shoulder angle≥35° was significant for all ages (5.89), and for patients aged<64 (10.3) while trauma was only a significant factor for patients aged≥64 (5.13). Age, trauma, and critical shoulder angle≥35° were related to rotator cuff tears in this study. However, these risk factors showed different trends according to age group, not a linear relationship.

Efficacy and safety of a new elastic tourniquet cuff in total knee arthroplasty: a prospective randomized controlled study

BackgroundThe effects of cuff shape, timing of tourniquet application, and automated systems using limb occlusion pressure (LOP) have been reported to minimize the appropriate tourniquet pressure. However, studies on the raw material of the cuff itself to reduce the complications related to the tourniquet have been very rarely reported. The purpose of this study is to report the efficacy and safety of a tourniquet system with a new elastic cuff in which pressure is set with LOP in total knee arthroplasty (TKA).MethodsA total of 63 patients who underwent primary TKA for osteoarthritis were enrolled from July to December 2015. Thirty-one patients were allocated to the new elastic cuff group and 32 in the conventional cuff group. Bloodless surgical field, pain visual analog scale (VAS) on the thigh, thigh circumference, range of motion, incidence of deep vein thrombosis, and muscle enzyme level after surgery were checked and compared between the 2 groups.ResultsOnly 1 of the 31 patients in the elastic cuff group required more pressure for obtaining a bloodless surgical field, whereas 4 of the 32 patients in the conventional cuff group required more pressure to complete surgery without being disturbed by sustained bleeding. Two patients in the conventional cuff group needed treatment for blisters and bullae at the tourniquet application site. There was no difference in pain VAS score, thigh circumference, range of motion, incidence of deep vein thrombosis, and level of muscle enzyme.ConclusionsA new elastic tourniquet cuff provided a more proper bloodless surgical field with less adjustment of tourniquet pressure despite a similar level of tourniquet pressure compared to the conventional cuff and had a low incidence of skin complications on the site of tourniquet application in TKA. These benefits make it an effective and safe medical device for orthopedic surgery requiring a tourniquet, such as TKA.

A novel method for prevention of stent graft-induced distal re-dissection after thoracic endovascular aortic repair for Type B aortic dissection†

Stent graft-induced distal re-dissection (SIDR) is a burdensome complication after thoracic endovascular aortic repair (TEVAR) for Type B aortic dissection. We developed a novel method to prevent SIDR by placing a small-diameter short stent graft [Excluder Aortic Extender (Cuff)] at the distal landing zone (DLZ) and reviewed its effectiveness in this study. Ninety patients who underwent TEVAR for Type B aortic dissection using commercially available devices between January 2008 and September 2016 were retrospectively reviewed. Among them, TEVAR with the Cuff technique was performed in 36 (40%) cases, in which a Cuff was placed at the DLZ in the descending aorta prior to the main stent graft deployment to avoid excessive stent graft oversizing at the distal end. The effectiveness of the Cuff technique was assessed by evaluating mid-term clinical results, including the incidence of SIDR. Technical success was achieved in all 90 cases. During a median follow-up time of 40.4 months (range 0.2-90.6 months), 8 SIDRs were documented using multidetector computed tomography images. Freedom from SIDR was significantly lower in the Cuff group (Cuff: 100%/5 years vs non-Cuff: 84.6%/5 years; P = 0.04), whereas no difference was observed between both groups in the oversizing rate at the DLZ (19.9 ± 8.5% vs 17.8 ± 9.9%; P = 0.29). Placement of a small-diameter short stent graft at the DLZ (Cuff technique) in TEVAR for aortic dissection is an easy procedure that may reduce the incidence of SIDR.

Microvascular blood flow in normal and pathologic rotator cuffs

Microvascular blood flow in the tendon plays an important role in the pathogenesis of rotator cuff abnormalities. There are conflicting views about the presence of a hypovascular zone in the supraspinatus tendon. Besides, no studies have looked at the pattern of blood flow around a partial-thickness tear. Our aim was to measure microvascular blood flow in normal and a range of pathologic rotator cuff tendons using laser doppler flowmetry. A total of 120 patients having arthroscopic shoulder surgery were divided into 4 equal groups on the basis of their intraoperative diagnosis: normal rotator cuff, subacromial impingement syndrome, and partial-thickness or full-thickness rotator cuff tear. Microvascular blood flow was measured at 5 different regions of each cuff using a laser doppler probe. The values were compared to assess variability within and between individuals. Total blood flow was greater in the normal rotator cuff group compared with the groups with pathologic rotator cuffs, with the largest difference seen in the subacromial impingement group. Within individuals, blood flow was highest at the musculotendinous junction and lowest at the lateral insertional part of the tendon. Among groups, the blood flow was significantly lower at the anteromedial and posteromedial cuff in the groups with impingement and full-thickness tears compared with the group with normal cuff. Real-time in vivo laser doppler analysis has shown that microvascular blood flow is not uniform throughout the supraspinatus tendon. Blood flow in the pathologic supraspinatus tendon was significantly lower compared with the normal tendon.

Correlation between glenoid inclination and critical shoulder angle: a radiographic and computed tomography study

Increased critical shoulder angles consist of both the acromial cover and glenoid inclination and have been found in patients with rotator cuff pathology. The purpose of this study was to determine the correlation of the critical shoulder angle and glenoid inclination and to determine the difference in glenoid inclination between patients with osteoarthritis and massive rotator cuff tears. The critical shoulder angle and glenoid inclination were measured on anteroposterior radiographs, and glenoid inclination was also measured on a validated 3-dimensional computer software program of 50 shoulders undergoing primary total shoulder arthroplasty. Twenty-five shoulders had osteoarthritis and A1 glenoids, as defined by the Walch classification, and were undergoing anatomic shoulder arthroplasty. The other 25 shoulders had massive rotator cuff tears and E0 glenoids, as defined by the Favard classification. The 2 groups were compared. Critical shoulder angle and glenoid inclination were significantly correlated (R(2) = 0.7426, P < .001). Shoulders with massive rotator cuff tears (E0) demonstrated increased glenoid inclination measurements than shoulders with osteoarthritis (A1). As measured by the 3-dimensional software, the massive rotator cuff group had a glenoid inclination of 13.6° ± 4.3° and the osteoarthritis group had a glenoid inclination of 4.7° ± 5.6°. When measured by anteroposterior radiographs, the average glenoid inclination was 13.6° ± 4.6° in the massive rotator cuff group and was 7.6° ± 5.01° in the osteoarthritic group . Glenoid inclination is linearly correlated with the critical shoulder angle and is significantly increased in patients with massive rotator cuff tears.

Correlation Between American Shoulder and Elbow Surgeons and Single Assessment Numerical Evaluation Score After Rotator Cuff or SLAP Repair

To compare the American Shoulder and Elbow Surgeons (ASES) and the Single Assessment Numerical Evaluation (SANE) scores after rotator cuff repair, rotator cuff revision, and SLAP repair. This study was a retrospective review of a prospectively filled database of 262 patients who underwent arthroscopic surgery for rotator cuff tears or SLAP lesions between 1999 and 2007. All patients were operated on by the same surgeon, with a minimum follow-up of 2 years. The patient database included preoperative and outcome measures, such as pain, range of motion, and notably postoperative ASES and SANE scores. Any patient with incomplete data was removed from the study. Three groups were identified: primary rotator cuff repair (n = 135), rotator cuff revision (n = 73), and SLAP repair (n = 54). The overall mean ASES and SANE scores after surgery were 82.7 (± 20.2) and 83.3 (± 19.6), respectively. The Pearson correlation coefficient (r) between both scores was 0.8 (P < .001), demonstrating a very good correlation. In subgroup analysis, the correlation was highest in the cuff revision group (r = 0.88; P < .001) followed by the SLAP group (r = 0.78; P < .001) and primary cuff group (r = 0.75; P < .001). This study shows that there is a significant correlation between postoperative SANE and ASES rating methods in rotator cuff and SLAP repairs. We recommend the SANE score as a reliable outcome indicator for iterative follow-up, which can then be combined with a more clinically informative score such as the ASES or other process-based scores for preoperative and final workup. Level III, retrospective comparative study.

Study of correlation between bigliani's acromion types and shoulder problems

Purpose of the study: Acromion Morphology have been implied to have a major role in shoulder pathology especially caused by affecting subacromial space. Among Acromion Morphology studied includes – Acromion Index, Acromion Types, and Acromion Slope etc. Acromion Types as classified according to Bigliani is a faster way to differentiate Acromion on a plain X-ray. Purpose of the study was to assess the effect of Acromion type on shoulder problems. Material and Methods: 100 Patients of above age 40 coming to orthopaedic OPD for shoulder problems (Impingement or rotator cuff pathology) were examined. Their Acromion type were assessed on the basis of x-ray of shoulder (supraspinatus outlet view). Acromion type was then classified according to Bigliani classification. Results: There were 100 patients in the study – 58 males and 42 females. There were 44 type I, 55 Type II and 01 Type III Acromion types accordingly to Bigliani‘s Classification. Mean age of study group was 56.67 ± 6.57.However in Impingement group patients were younger (55.4 ± 6.53) as compared to rotator cuff group patients (58.84 ± 6.06).There were more females in Type I Acromion group and subsequently number of males outnumbered females in Acromion Type II and Type III. There were 63 patients in Impingement group and 37 in rotator cuff group. Right sided shoulders were affected in 68 patients and 32 patients had their left shoulders affected. 73 affected shoulders were of dominant sides. Conclusion: As Acromion Type changes from Type I to Type III, then symptoms of impingement and rotator cuff pathology start to appear at a younger age. This warrants aggressive approach of management of these shoulder pathology in Acromion type II and type III. Keyword: Acromion Types, Bigliani, Impingement,

Randomized trial of tourniquet vs blood pressure cuff for target vein dilation in ultrasound-guided peripheral intravenous access

BackgroundTen percent of the time, peripheral intravenous access (PIV) is not obtained in 2 attempts in the emergency department. Typically, a tourniquet is used to dilate the target vein; but recent research showed that a blood pressure (BP) cuff improves dilation, which may translate to increased PIV success. ObjectivesWe sought to determine if there is improved success in obtaining ultrasound-guided PIV using a BP cuff vs a tourniquet in “difficult stick” patients. MethodsThis is a prospective, randomized, single-blinded trial. Adult patients requiring PIV with at least 2 prior failed attempts were enrolled. Patients were assigned to tourniquet or BP cuff for target vein dilation randomly. Nurses prepared the patient for PIV attempt by either placing a BP cuff inflated to 150 mm Hg or placing a tourniquet on the chosen extremity. The extremity was draped to blind the physician to assignment. Physicians then attempted ultrasound-guided PIV. Failures were defined as IVs requiring greater than 3 ultrasound-guided attempts or 30 minutes, or patient intolerance. If failure occurred, the physician was unblinded; and the patient could be crossed over and reattempted. ResultsThirty-eight patients were enrolled. The success rate for the tourniquet group (n = 17) and BP cuff group (n = 21) was 82.4% and 47.6%, respectively (P = .04). There were no differences between groups for vessel depth, diameter, or procedure time. Six in the BP cuff group were crossed over and had successful PIV obtained with tourniquet. ConclusionsTourniquet is superior to BP cuff for target vein dilation in ultrasound-guided PIV.

Recurrence and survival outcomes following adjuvant therapy for early-stage uterine serous carcinoma (USC).

e16556 Background: The choice of adjuvant therapy for early-stage USC remains controversial. The objective of this study was to estimate the recurrence rates of patients with surgically resected early-stage USC stratified by observation alone or adjuvant therapy. Methods: A retrospective review of women with surgically-staged stage IA-II USC followed at M.D. Anderson Cancer Center between January 2000 and December 2011. Descriptive statistics were used to summarize the demographic and clinical characteristics of patients. We estimated the cumulative incidence of disease recurrence, overall survival (OS), and recurrence-free survival (RFS) as a function of adjuvant therapy received. Adjuvant therapy groups listed in the Table. Results: 80 patients included in study. 58 patients had stage IA, 14 had stage IB, and 8 had stage II disease. Mean age was 66.4 years. Median follow-up for all patients was 4.83 years (range: 0.02 – 18.16). Cumulative incidence of recurrence for the whole group was 0.18 (95% CI: 0.10 – 0.28) which was reached at 3.96 years and remained at this rate until rising to 0.23 (95% CI: 0.12 – 0.36) at 11.12 years. Adjuvant treatment was not significantly associated with decreased risk of recurrence (Table). RFS at 5 years for the whole population was 0.71 (95% CI: 0.59 – 0.80) and OS at 5 years was 0.76 (95% CI: 0.63 – 0.85). Adjuvant treatment was not significantly associated with RFS or OS. In a subset of stage IA patients, 4 of 27 patients in the observation or cuff alone group recurred compared with 1 of 16 patients in the chemotherapy +/- cuff group (HR 0.48, CI: 0.05 – 4.27, p=0.511). Conclusions: In this study, there were no observed differences between observation and adjuvant treatment modalities in recurrence rates or survival outcomes for patients with early-stage USC. The addition of adjuvant chemotherapy may reduce risk for recurrence in stage IA patients, but further study is needed. [Table: see text]

Interposition vein cuff for infragenicular prosthetic bypass graft

The use of prosthetic grafts such as polytetrafluorethylene (PTFE) or Dacron to bypass occluded arteries in the lower leg is an accepted practice in the absence of suitable autologous vein. The aim is limb salvage or functional improvement in critical limb ischaemia, but patency rates for below knee prosthetic bypasses are low. Creating a vein cuff at the distal anastomosis is thought to improve outcomes. Other techniques including the use of pre-cuffed synthetic grafts, spliced segments of vein and the creation of an arterio-venous fistula (AVF) are also used to improve patency. To compare the beneficial effects of using vein cuffed prosthetic grafts for below knee bypass in critical limb ischaemia with other types of reconstruction. The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched May 2012) and CENTRAL (2012, Issue 5) for publications comparing prosthetic infragenicular bypass using vein cuffs with other bypass techniques. Randomised controlled trials comparing interposition vein cuff prosthetic graft with autologous vein graft and non-cuffed prosthetic graft for infragenicular bypass in patients with critical limb ischaemia were included. Trials comparing vein cuff prosthetic grafts with or without AVF and vein cuff prosthetic grafts with pre-cuffed prosthetic grafts were also included. The trials were selected and assessed independently by two review authors. Six trials with a combined total of 885 patients were included in this review. Only studies using prosthetic PTFE grafts were identified.Two trials compared PTFE graft with or without a vein cuff. In one underpowered trial for below knee bypass the cumulative primary patency rate was statistically significantly higher in the vein cuff group (80.3% versus 65.3% at 12 months and 51.8% versus 29.1% at 24 months, P = 0.03). There was no statistically significant difference in secondary patency (82.9% versus 72.5% and 58.6% versus 34.9%, P = 0.14) and limb salvage rates (86.3% versus 71.8% and 82.6% versus 62.2%, P = 0.08) at 12 and 24 months respectively. The other trial showed no statistically significant difference between the groups at three years in the below knee femoro-popliteal bypasses (primary patency rate 26% (95% confidence interval (CI) 18 to 38) and 43% (95% CI 33 to 58), secondary patency rate 32% (95% CI 23 to 44) and 42% (95% CI 31 to 56) and limb salvage rate 64% (95% CI 54 to 75) and 61% (95% CI 50 to 74) in the collar and no collar groups respectively). In the femoro-distal bypass group, the differences in primary patency, secondary patency and limb salvage rates were also not statistically significant at three years (primary patency rate 20% (95% CI 11 to 38) and 17% (95% CI 9 to 33), secondary patency rate 22% (95% CI 12 to 39) and 20% (95% CI 11 to 35) and limb salvage rate 59% (95% CI 46 to 76) and 44% (95% CI 32 to 61) in the collar and no collar groups respectively).One trial compared pre-cuffed PTFE grafts with vein cuffed grafts. There was no statistically significant difference in primary patency rate (62% pre-cuffed PTFE versus 52% vein cuff PTFE and 49% versus 44%, P = 0.53), secondary patency rate (66% pre-cuffed PTFE versus 53% vein cuff PTFE and 55% versus 50%, P = 0.30) or limb salvage rate (75% pre-cuffed PTFE versus 72% vein cuff PTFE and 62% versus 65%, P = 0.88) at 12 and 24 months respectively.One trial compared spliced vein grafts with vein cuffed PTFE grafts. At 24 months, the secondary patency rate was statistically significantly higher in the spliced vein group (86% in the spliced vein and 52% in the vein cuff group, P < 0.05). There was no statistical significant difference in primary patency rate (44% versus 50%, P > 0.05) and limb salvage rate (94% versus 85%, P > 0.05).Two trials compared vein cuff PTFE grafts with and without AVF. There was no statistical significant difference at 24 months in primary patency rate (29% versus 36%, P = 0.77; 32% versus 28%, P = 0.2), secondary patency rate (40% versus 40%, P = 0.89; 28% versus 24%, P = 0.2) and limb salvage rate (65% versus 70%, P = 0.97; 62% versus 71%, P = 0.3). There is evidence that a vein cuff at the distal anastomosis site improves primary graft patency rates for below knee PTFE graft, but this does not reduce the risk of limb loss. Pre-cuffed PTFE grafts have comparable patency and limb salvage rates to vein cuff PTFE grafts. The use of spliced veins improved secondary patency but this did not translate into improved limb salvage. The use of an AVF alone showed no added benefits. Evidence for a beneficial effect of vein cuffed PTFE grafts is weak and based on underpowered trials. A large study with a specific focus on below knee vein cuff prosthetic grafts, including PTFE, is required.

Mid-term results of arthroscopic subacromial decompression in patients with or without partial thickness rotator cuff tears

Aim:To evaluate mid-term outcome in patients who underwent arthroscopic subacromial decompression (ASD) for shoulder impingement syndrome with intact and partially torn rotator cuffs.Materials and Methods:A total of 80 consecutive patients (83 shoulders) who underwent ASD for impingement syndrome between 2003 and 2006 were analyzed. Mean age was 57.1 years. Patients’ self-reported Oxford Shoulder Score (OSS) for pain was collected prospectively and was used as an instrument to measure surgical outcome.Results:The mean initial and final OSS for patients with an intact rotator cuff was 26.1 and 40.3, respectively, at a mean follow up of 71.9 months (nearly 7 years). The mean initial and final OSS for patients with a partially torn articular sided tear was 22.6 and 41.9, respectively, at mean follow up of 70.7 months. Both groups showed significant sustained improvement (P < 0.0001). The mean improvement of OSS following ASD was statistically greater (P < 0.03) for partially torn rotator cuff group (19.3 points) as compared to those with normal rotator cuff (14.2 points).Conclusion:Patients with dual pathology (partial rotator cuff tear and impingement) appreciated a significantly greater improvement following ASD compared to those with impingement alone. Both groups of patients had a similar final outcome at a mid-term follow up.Level of Evidence:IV, retrospective study on consecutive series of patients.

The effect of interval training combined with thigh cuffs pressure on maximal and submaximal exercise performance

The purpose of the study was to investigate the effect of interval training combined with a thigh cuffs pressure of +90 mmHg on maximal and submaximal cycling performance. Twenty untrained individuals were assigned either to a control (CON) or to an experimental (CUFF) training group. Both groups trained 3 days per week for 6 weeks at the same relative intensity; each training session consisted of 2-min work bout at 90% of VO(2max): 2-min active recovery bout at 50% of VO(2max). An incremental exercise test to exhaustion, a 6-min constant-power test at 80% of VO(2max) (Sub(80)) and a maximal constant-power test to exhaustion (TF(150)) were performed pre- and post-training. Despite the unchanged VO(2max), both groups significantly increased peak power output (CON: ∼12%, CUFF: ∼20%) that was accompanied by higher deoxygenation (ΔStO(2)) measured with near-infrared muscle spectroscopy. These changes were more pronounced in the CUFF group. Moreover, both groups reduced VO(2) during the Sub(80) test without concomitant changes in ΔStO(2). TF(150) was enhanced in both groups. Thus, an interval exercise training protocol under moderate restricted blood flow conditions does not provide any additive effect on maximal and submaximal cycling performance. However, it seems to induce peripheral muscular adaptations, despite the lower absolute training intensity.